Patient Forms

Click on the links below to download the patient forms.
They can then be printed and filled out before your first visit.

Adult Forms

PBH Adult Intake Packet
PBH Adult Office Policies Client Copy

Child/Adolescent Forms

PBH Child Adolescent Intake Packet
PBH Child/Adolescent Office Policies Client Copy

Privacy Policy

Notice of Privacy Policy

Release of Information

PBH Release of Information

Please be sure to have all intake paperwork done prior to your scheduled appointment time. Have your paperwork, insurance card, and driver’s license ready for our clerical staff.

  • Pickerington Office Hours:

    • Mon:  7:30A - 7:00P
    • Tue:   7:30A - 7:00P
    • Wed: 7:30A - 5:00P
    • Thu:  7:30A - 7:00P
    • Fri:    7:30A - 4:00P
    • Sat:  (limited to first Sat. morning of each month. Not all therapists provide Sat appointments. Call for details.)

    Lancaster Office hours:

    • Mon:  7:30A - 4:00P
    • Tue:   7:30A - 7:00P
    • Wed: 7:30A - 5:00P
    • Thu:  7:30A - 6:00P
    • Fri:    CLOSED

    Clients are seen on an appointment basis and sessions range from 45 - 60 minutes. An attempt is made to arrange a time which is most convenient for the client.

  • Major Insurances Accepted:

    • Access Health
    • Aetna
    • Anthem - All B/C & B/S policies
    • Bureau of Workers Compensation
    • Caresource
    • Core Source
    • Cigna
    • Magellan
    • Medical Mutual
    • Medicare
    • Medigold
    • Ohio Health
    • Ohio PPO Connect
    • Optum
    • UHC/UBH
    • UHC Community Plan
    • Value Options

    If your insurance company is not listed, you can confirm our network participation by calling the phone # on the back of your insurance card or give us a call to ask our clerical staff.

  • Fee Schedule

    Initial visit: $160
    Individual/couple/family visit: $120-$150
    (varies according to time spent and service provided)